Tag: infant deaths

Campaigners have called for a Garda investigation into why the religious order which ran Bessborough Mother and Baby Home reported significantly higher numbers of infant deaths to state inspectors than it recorded privately.

An Irish Examiner investigation found between March 31, 1939, and December 5, 1944, Department of Local Government and public health inspector Alice Litster had been informed 353 infant deaths occurred at the Cork-based institution. The figures are contained in a inspection report from 1944 obtained by this newspaper.

However, the Bessborough Death Register revealed the nuns had recorded just 273 infant deaths in that period — a discrepancy of 80.

The discrepancy in the recording of deaths comes just months after this newspaper revealed an unpublished 2012 internal HSE report had raised concerns death records had been falsified in Bessborough Mother and Baby Home so children could “be brokered in clandestine adoption arrangements” at home and abroad.

Susan Lohan of the Adoption Rights Alliance said the gardaí now needed to become involved in order to ascertain why such a large discrepancy in the figures exists.

“We have been advised on numerous occasions by both the Minister for Children James Reilly and chairman of the Adoption Authority Geoffrey Shannon that if we believed there was evidence of wrongdoing to report it to the relevant authorities. It’s now time the gardaí investigate where these 80 infants are,” she said.

Ms Lohan said her organisation was regularly contacted by people who believe they were adopted from Ireland but when they contacted the Department of Foreign Affairs, they had been told they did not appear in the records relating to the export of babies to the US found in the National Archives in 1996.

Paul Redmond of the Coalition of Mother and Baby Homes Survivors has also called for a garda investigation into the issue of how deaths had been recorded at Bessborough.

“The Bessborough Death Register is another example of the Sacred Heart nuns’ complete disregard for the lives of babies and children in their care who died from neglect and indifference. The missing babies should be reported to the Garda and a full criminal investigation is necessary,” he said.

Independent senator and former Children’s Rights Alliance chief executive Jillian van Turnhout said she was “hugely concerned” at the discrepancies.

“If there is no register, as the order have said, then where are the other 80? We know that clandestine adoptions happened. It is reasonable to ask the question: ‘Is there a chance that there are people out there in their 70s that are adopted and do not know?’”

The Commission of Investigation into Mother and Baby Homes has said it will investigate the discrepancy in the figures.

The Sisters of the Sacred Hearts of Jesus and Mary said it was dealing directly with the commission on all such and related matters — and it “would not be appropriate to enter into communication, other than with the commission at this time”.

The State feared a “public scandal” in relation to the alarming number of children dying in mother and baby homes — 70 years before the Tuam babies scandal made worldwide headlines.

The revelation is contained in a letter sent on behalf of parliamentary secretary to the Minister for Local Government and Public Health Dr Con Ward in 1945 to the Bishop of Cork Daniel Cohalan.

The letter was in response to an angry letter sent to Dr Ward by Bishop Cohalan where he questioned the department’s request that the order remove the head of Bessborough over the “trouble” of infant mortality at the institution.

Records show there was an 82% infant death rate at Bessborough at the time.

“Rev Mother Martina has informed me that the Mother Superior in England was asked to remove her. That procedure was scarcely correct. Mother Martina is Reverend Mother of the Community of Sisters, it is an ecclesiastical appointment; it was not a correct thing to call for he removal,” he wrote.

However, in response, the department was clear that should information about the number of children dying leak into the public domain, it would result in a “public scandal”.

“The parliamentary secretary is only concerned with her position as matron of a home in which the death rate has reached an exceptionally high figure. The fact that 102 babies died in the institution before reaching the age of 12 months during the year 31st March last — the total infants born in the home and admitted after birth in that year being 124 — is viewed with disquietude.

“Apart from any public scandal which might result, the parliamentary secretary felt that the case called for immediate action and that to allow the Rev Mother Martina to continue as manager would mean acquiescence on his part in the state of affairs which has been disclosed,” stated the letter.

The 102 deaths referred to an 82% death rate at Bessborough reported to inspector Alice Litster for year ended 31 March 1944. Last week, the Irish Examiner revealed that this figure was substantially higher than the level of deaths the order recorded in its own death register.

Bishop Cohalan informs the department that he had spoken to the ex-chaplain at Bessborough and Sr Martina and that “the seriousness of the problem is realised”.

“The view is that a young doctor is needed, not a general practitioner but a specialist in gynaecology; that with a young doctor — gynaecologist — the cause of the mortality would be soon discovered and a remedy found,” he said.

The department agreed with this assessment but also expresses the hope that the re-organisation proposed by the superior-general of the order, whereby “an efficient and energetic Matron was to be transferred from Shan Ross to Bessboro, will have Your Lordship’s support”.

The HSE expressed repeated concerns that the past actions of Bessborough adoption agency meant it had to be indemnified against any legal action taken by people seeking their records.

The concerns were raised throughout 2009 and 2010, in material released under Freedom of Information Act, as the Sisters of the Sacred Hearts of Jesus and Mary prepared to cease operating Bessborough as an adoption agency and transfer some 15,000-plus files to the HSE.

An undated memo of a meeting the HSE held with the management group from the religious order notes its desire to “manage liability for past Bessboro responsibility and ongoing re their activities as an adoption agency when and if it arises”.

In a letter on February 8, 2010, to solicitors representing the order, childcare manager in the HSE South region, Mike van Aswegen, said the HSE needed this assurance, as it had reason to believe that the past practices of the agency had “not always been exemplary”.

“In your correspondence, you refer to the need for providing an indemnity. I believe that in this case we will need to be provided with this comfort, as we have good reason to believe that the practice from the agency has in the past not always been exemplary,” he wrote.

Another memo from 2010 referenced legal advice that such indemnity would be required to protect the HSE: “Following legal advice to the HSE a further meeting took place on October 5, 2010. At this meeting matters concerning previous practice in the Society was discussed, and the issue of the Society indemnifying the HSE in the event that any claims would be made against the Society for past activity. The legal advice from the HSE solicitors had been that to safeguard the HSE this would be advisable.”

However, a non-dated service agreement briefing note, which appears to be from 2010, reveals that the order were initially not keen to indemnify the HSE.

“The Society stated they were not in a position to continue the arrangement of employing the staff nor were they prepared to indemnify the HSE should the HSE take over the files and the work involved in Search and Reunion,” read the memo.

An agreement was eventually reached with the order whereby it agreed to indemnify the HSE against “all liabilities, claims, charges, expenses, wrongdoing, losses or demands for an indefinite period”.

The order is also obliged to notify the HSE immediately when it becomes aware of any claim or potential claim being made against it.

In November of last year, an Irish Examiner investigation revealed the religious order which ran the Bessborough Mother and Baby Home reported significantly higher numbers of infant deaths to state inspectors than it recorded privately.

This came just months after another investigation revealed an unpublished 2012 internal HSE report raised concerns that death records were falsified in Bessborough Mother and Baby Home so children could “be brokered in clandestine adoption arrangements” at home and abroad.

In a statement, the order declined to comment on the HSE concerns about its past actions, stating it was dealing with the Commission of Investigation into Mother and Baby Homes “on all such and related matters” and that it would “not be appropriate to enter into communication, other than with the Commission at this time”.

The reaction of the Government to a shocking 2012 HSE report on Bessborough Mother and Baby Home has been instructive.

The revelations contained in the report have clearly put it in an uncomfortable position. Despite the shock displayed once the Tuam babies story went global — it is now clear that the Government had possession of a report showing a higher death rate in Bessborough almost two years earlier.

When the report, compiled as part of the HSE’s examination of the State’s role in the Magdalene Laundries as part of the McAleese inquiry, was made public by the Irish Examiner in June, along with equally disturbing material relating to Tuam Mother and Baby Home, the reaction of Government was to first deny it had ever seen it, then admit that, in fact, two departments had the report before finally labelling the entire study “conjecture”.

Even if you accept the “conjecture” line, it is impossible to get away from the finding on the number of infant deaths at Bessborough.

They are worth repeating. Between 1934 and 1953, Bessborough’s Registration of Deaths ledger records a “shocking” 478 children as having died at the institution.

To put this into context, this death rate is higher than that found by Catherine Corless in Tuam almost two years later – research which led directly to the State inquiry.

If the Government was so horrified by the death rate found in Tuam that it felt compelled to launch a State inquiry, then why was it not similarly moved in 2012?

When the Irish Examiner first revealed details of the HSE report, the Department of Children and Youth Affairs said it had no knowledge of the report. The department has since altered this position, stating that not only did it have a copy of the report, but so did the Department of Health. In a series of responses to parliamentary questions, children’s minister Dr James Reilly has sought to defend the lack of action on the deaths – which are described as “wholly epidemic”, “shocking” and a “cause for serious consternation” – by stating the 2012 report’s findings are “a matter of conjecture”.

It is important to put this “conjecture” line to bed. Firstly, the 2012 HSE report is based on an examination of Bessborough’s own records spanning from 1922 to 1982. These were transferred to the HSE by the order that ran the home — the Sisters of the Sacred Hearts of Jesus and Mary — in 2011. The 478 deaths recorded are taken directly from the order’s own death register. Based on the records, the author outlines a “narrative of patterns and practices of the Sacred Heart Order in the provision of adoption services at Bessboro”.

The records reveal an institution where women and babies were considered “little more than a commodity for trade amongst religious orders”, where “institutionalisation and human trafficking” took place among various religious orders and state-funded institutions and where women were provided with “little more than the basic care and provision afforded to that of any individual convicted of crimes against the State”.

The report is rock solid on the number of deaths listed, but says the question of whether or not all these children died but were instead “brokered” in clandestine adoption arrangements both at home and abroad was one which needed to be examined as part of a forensic investigation. It also says “further investigation is warranted” into the order’s accounting practices.

The records reveal clearly that the order requested payment from adoptive parents for the children they were adopting, while also requiring payment from the natural mothers for the care both they and their children received at the institution.

The author of the HSE report does state that the conclusions of the report were conjecture but, as always, context is everything.

The remark was in reference to establishing the interaction between the state, the order running Bessborough and the order operating the two Magdalene Laundries in Cork, and clearly indicates the Bessborough files reveal enough disturbing information to warrant a full forensic investigation.

“In order to conclusively verify interaction between the State and the Good Shepherd Sisters (who operated Magdalene Laundries in Sunday’s Well and Peacock Lane, Cork) and the Sacred Heart Order, it is imperative that full disclosure of any and all case files, records, institutional accounts and communications between the State and the religious orders be subject to forensic investigation. Until such time the conclusions of any such examination,” states the report.

None of the concerns raised in the Bessborough report are mentioned in the McAleese Report, nor does it appear any further investigation was done into the report’s findings.

The 2014 inter-departmental report on Mother and Baby Homes listed just 25 infant deaths at Bessborough, despite two Government departments being in possession of the order’s own figure of 478.

Dr Reilly has defended these omissions stating the findings were not “validated” and Mother and Baby Homes were outside the remit of the McAleese Committee. “As the issues raised in this draft report regarding death rates in Bessborough were outside the direct remit of the McAleese Committee, the HSE advised that these and other concerns would be examined separately by the HSE. At that time my department advised the HSE that any validated findings of concern from this separate process should be appropriately communicated by the HSE. My department is not aware of any subsequent report on this matter by the HSE,” he said.

This indicates that the department does not feel that a figure of 478 deaths taken directly from Bessborough’s Registration of Deaths transferred to the State by the order constitutes a “validated finding”.

While it is true that Mother and Baby Homes were outside the remit of the McAleese inquiry, that report points out that the committee uncovered material that was, “strictly speaking, outside its core remit” but chose to include it “in the public interest”.

This was because some of this material “may challenge some common perceptions” about Magdalene Laundries.

A previously unpublished report by the HSE in 2012 examined Bessborough’s own records. The in-depth findings and conclusions are damning. Conall Ó Fátharta reports

FOR years, places like Bessborough Mother and Baby Home were spoken of in hushed tones.

For generations of Irish people, they were places where thousands of women and girls were sent when they had “a problem”. They went in pregnant and came out alone, some after spending years locked away.

Some left only to be moved to other institutions and Magdalene laundries. Most were never the same. Their voices were never heard.

Over the years, those women have found their voices and have demanded answers for how they were treated behind the walls of Ireland’s mother and baby homes. Adoption rights campaigners have been doing the same.

Former residents and lay staff at the Bessborough home, run by the Sisters of the Sacred Hearts of Jesus and Mary, have spoken of an institution where women were denied pain relief in labour and basic medical care after birth, and were humiliated by having to cut the institution’s vast lawns on their hands and knees with a scissors.

Just last year, this newspaper uncovered that an official investigation carried out by the Cork County medical officer, on foot of inquiries from an inspector with the Department of Local Government, confirmed an infant mortality rate of 68% at Bessborough in 1943. The government briefly stopped sending women there as a result.

A previously unpublished 2012 HSE report on Bessborough, which examined the institution’s own records, show a system of “institutionalisation and human trafficking”, where “women and babies were considered little more than a commodity for trade amongst religious orders”, in an institution where women were provided with little more than the care and provision given to someone convicted of a crime against the State.

The report was prepared as part of the HSE’s examination of interventions by Irish State health authorities in the Magdalene laundries. It was based on an examination of Bessborough’s own records, which were handed over to the HSE in 2011.

Culture of greed

From the outset, the report, released under the Freedom of Information Act, is crystal clear in what the Bessborough archives reveal. It outlines an order preoccupied with materialism, wealth, and social status, where the women and children in their care were considered as a means to making money.

It points out that “a cultural snapshot” emerges of an era in Ireland where unmarried mothers were considered “not only as “fallen women” and violators of Roman Catholic moral order but were “considered little more than a commodity for trade amongst religious orders”

The report notes that, even though detailed financial records and accounts were not handed over to the HSE by the order, the archives still reveal that the order earned money from the women for the care of their children and also from the adoptive parents who took them.

“The only written confirmation of monies being paid were detailed within the ‘Catholic Women’s Aid Society Book 2, 1929-40’. Even a cursory glance at these pages reveals that monies were paid by natural mothers for the care of their babies, while adoptive parents were charged a sum ranging between £50-£60, payable on a monthly payment scheme in exchange for their adopted child. Further investigation into these practices is warranted,” the report states.

The admission books for the mother and baby home between 1922 and 1936 show the nuns “assigned account numbers to some women, (while not others) while marking some entries as ‘private’, ‘paid nothing’, or identifying which institutions or State bodies were financially responsible for the women’s upkeep“.

In other admission books, similar accounting practices were observed where women “were commonly assigned a ‘Reg No’, ‘Order Form No’, ‘Pink Form No’, ‘Admission Card’, ‘Admission Ticket’, or a notation of a ‘Card Received’.”

Minutes from meetings of the Sacred Heart Adoption Society’s board of management “further lend evidence to the order’s preoccupation with materialism, wealth, and social status” while the wealth and social status of the adoptive parents was often the prime concern when deciding whether they would receive a child.

“While an explicit criteria for adoption at Bessborough could not be located within any materials available during this research, it would appear from the board of management meeting minutes that prospective adoptive parents were assessed on the basis of their earnings, the size and condition of their home, and their social status within the community (not to mention the fundamental expectation that couples were practising Catholics), age, years married, and the committee’s ‘impression’ were mentioned most often as deciding factors [in] whether the couple would be ‘passed’ and ‘given a baby’ or not.”

The report lists a number of remarks at monthly meetings of the board of management between 1974 and 1982, stating that “one can formulate their own opinions about the relationships and interactions between Church and State and the judgements placed upon prospective adopters, and the attitudes toward the babies for whom they were entrusted”.

The entries include:

“Ages, 34 & 36, married 4-and-a-half years, Do not want a baby until Christmas.” (From the board of management minutes, April 9, 1979.)

“A very nice couple living in Limerick, their own hotel. The ages are 44 & 31; they have a very happy home and plenty of this world’s goods. Would like to adopt a baby. The committee passed them, and if babies are to spare they will get one.” (From the board of management minutes, June 13, 1977.)

Another entry from March 1977 reveals the “lax attitude of the Sacred Heart trustees toward child protection”: “Ages are 32 years… They are married 10 years and have a very comfortable home. They have all the necessary investigations… They are anxious to adopt a little girl. They have received a good reference from the priest but no Garda clearance.” This entry is then followed by the declaration “Passed”.

Shocking phenomenon of child deaths

The Bessborough files also raise questions about the “shocking” number of children who died in the institution. The report raises the question of whether death records were falsified so children “could be brokered into clandestine adoption arrangements, both foreign and domestic”.

It notes that, if this proves true, it could “have dire implications for the Church and State”, not to mention the families involved.

The HSE report reveals, for the first time, the exact number of children that were recorded as having died at Bessborough and states that the numbers unearthed “are a cause for serious consternation“.

“Though an examination of Sacred Heart’s Admission Register SHA/4 (1933-1953) accounts for 93 recorded infant deaths (not including those recorded as ‘stillborn’), a cross-reference with Bessborough’s Registration of Deaths ledger (1934-1953) unearthed a shocking phenomenon of infant mortality as 478 infant deaths were recorded for 19 years.”

That amounts to a death rate of 25 children a year. To put that in perspective, a total of 796 children are recorded as having died in Tuam Mother and Baby Home between 1925 and 1960 — a death rate of almost 23 children every year.

“As Bessborough’s death register contains less than two decades of details of Sacred Heart Adoption Society’s almost 75-year history, one cannot be certain as to the full scope of infant deaths. Curiously there are no death records for any years following 1953,” the report notes. However, the HSE does specifically raise the issue of what sort of conditions were present in the institution to allow such a “shocking” rate of infant death to occur.

“Returning to the matter of the death register, a phenomenal 478 documented infant deaths over 19 years leaves the reader asking what conditions precipitated the deaths of so many babies under the trust of the Sacred Heart Order.

“While a thorough inquiry is beyond the remit of this paper, one cannot help but ponder the implications of this phenomenon.”

In August of last year, this newspaper uncovered material in the Cork City and County archives which shows an official investigation into deaths in Bessborough carried out by the Cork County medical officer in 1943 confirmed an infant mortality rate of 68%.

The HSE report states that, in addition to revealing the number of babies that died between 1934 to 1953, the death record at Bessborough lists each child’s date of death, address, name, gender, age at last birthday, profession (marked as son or daughter), cause of death, and, in some cases, the duration of illness and the date when the death was registered.

Inexplicably one entry which records a child dying of prematurity states that the child had turned three years of age at her last birthday.

Disturbing as these revelations are, perhaps the most shocking claim made in the HSE study is that death records may have been falsified for children so that they could be “brokered” for adoption, perhaps both at home and abroad.

“The question whether indeed all of these children actually died while in Bessborough or whether they were brokered into clandestine adoption arrangements, both foreign and domestic, has dire implications for the Church and State and not least for the children and families themselves,” the report states.

It notes that, while the subject of infant mortality may not appear to have much to do with adoption, the ‘boarding out’ of children with foster families, or the discharge strategies of women and children, its relevance becomes apparent “when put in context with the broader issue of the mutually beneficial State/religious order relationships and the covert relationships of the day”.

“Simply put the State had a social problem that it desperately needed to make go away, while the Church had the power and control to turn the ‘problem’ of illegitimacy into a lucrative money making enterprise,” the report states.

“While it is beyond the expertise of this author to proffer grand narratives about the historical, fiscal, or social arrangements forged between Church and State, the records themselves expose a telling indictment of what may have been one of Ireland’s most damning and destructive partnership of collusion, corruption, and abuse between Church and State.”

Institutionalisation and human trafficking

The archives paint an equally disturbing picture of how women were treated, with references to “institutionalisation and human trafficking”, “incarceration”, “confinement and servitude”, and to “a cold and lonely environment characterised by harrowing social, emotional, and physical isolation”.

The report points out that, while it is historically and socially acknowledged that little regard was given to the care of women pregnant out of wedlock in Ireland at that time, nonetheless “it appears that the women who sought refuge within Bessborough Adoption Society were provided with little more than the basic care and provision afforded to that of any individual convicted of crimes against the State”.

“While it is noted that entrants to Bessborough were not subject to the sanctions of any Irish court order, however their ‘voluntary’ admissions appear to have been a punitive reprise, far worse than a prison term,” states the report.

The report is also scathing about the “culture of confinement” which existed at Bessborough and a “practice of protracted detainment” where women and girls were kept in the institution long after their children were born and they should have been fit for discharge.

Analysis of admission records between 1922 and 1936 show that details for a “staggering” 43% of admissions had no recorded information regarding how they were referred to Bessborough. The second largest category of referrals reveals that 16% of admissions for this period were “By Ambulance”, while 15% came from family relations.

The HSE study notes that the figure of 43% could be interpreted as an administrative oversight save for the high level of specificity of details regarding a wide range of other referral mechanisms. For example, other referral mechanisms listed include:

GPs (11%);

Hospitals/Matrons (3.7%);

Nuns/Priests/Canons/Mother Superiors (2.7%);

County Homes (2.2%);

Cork Guardians (1.3%);

Other (1.2%);

Readmissions (1%);

Good Shepherd Sisters (0.5%);

Cork Union (0.5%);

Civic Patrol (0.1%);

Sr of Mercy (0.1%);

Sr of Charity (0.1%);

Bandon Guardians (0.1%);

Relieving Officer (0.4%);

Kilkenny CBH (0.4%);

England (0.3%).

Similarly, between 1933 and 1954, the sources of referral were unknown for 56% of 302 admissions.

Once admitted to Bessborough, the records examined by the HSE were found to “attest to the culture of confinement and servitude” and the “powerful air of authority that the nuns conveyed”.

“Society at large did not question the legitimacy of the Sacred Heart Order’s alleged powers of detainment; many of the women were kept there long past their delivery dates. It would appear that freedom to leave in one’s own time was beyond the reach of many women,” the report states.

Reference is made to one girl being sent to Bessborough in 1922 despite no record of her “being pregnant or ever having delivered a baby or what became of her after she entered the Good Shepherds”.

“What we can glean from this account is the prevailing morality of the times which sanctioned the incarceration of young females in an effort to prevent their moral degeneration. In this particular case mentioned, the young girl was accused of ‘being lead (sic) astray by a man’ so being locked up was considered justified.”

The HSE study states that Bessborough’s archives “reveal a trajectory of institutionalisation and human trafficking among various religious orders and State-funded institutions”.

However, the State is also singled out for harsh criticism for failing in its legal and ethical responsibility to ensure that the rights of unmarried mothers, particularly those under the age of majority, were safeguarded.“

Instead it would appear that the State turned their back on these women and girls, favouring instead to abdicate its responsibility to the religious orders.

“In exchange for assuming the State’s social and legal responsibility, the nuns benefited from a steady stream of free labour and servitude (not to mention financial remuneration for the women and their offspring).

“The practice of transferring women and children among and between State-funded religious institutions was prolific.”

Admission records

Indeed, the admission records of Bessborough reveal well-established practices of women and/or their babies being sent to “County Homes Unions, industrial schools, and orphanages, and within the network of convents and religious orders both domestically and within the United Kingdom” — in a practice that continued throughout the 1950s.

The report notes that the prevalence of such practices is witnessed by the scale of references within the admission registers “to women and children being bandied about from and within religious orders and institutions”.

The report outlines a snapshot of these practices of women and children being transferred among and between State and religious-run institutions as described in the Bessborough admission books between the 1920s and 1950s.

They include:

“Miss X age 22 sent to ‘Rev Mother St Mary’s School, North Hyde, Child placed in the school, March 1, 1926’”;

“Miss X age 21 Sent to Sanatorium, 18 , November 1927, Rtd (sic) 17.05.1928, Sent to Co Hospital, 05.09.1928’”;

“Miss X age 18 having already spent three years in the care of the Good Shepherd Nuns in Co Kilkenny was admitted to Bessborough on the 12/11/25 (two years after the birth of her baby on 21/02/1923). This young woman was returned to the Good Shepherds on 12/02/1930”;

The report concludes by noting that the question regarding “the interconnectedness between Church and State demands a much more comprehensive exposition than has been offered here.

“The interdepartmental committee has a weighty task ahead of it as it seeks to ascertain the full scope of State/Church relationships, a formidable task by any standards.

“It is my hope that the material provided within this research paper is in some manner useful to the committee in making its conclusions.

“It goes without saying that the dignity and integrity of the women and children, both living and dead, who once lived behind Bessborough’s walls must be safeguarded and at long last their voices heard.”

In a statement, the Sisters of the Sacred Hearts of Jesus and Mary said it had “no knowledge of any such report”.

“We are in contact with the commission in regard to the mother and baby homes inquiry, which will be having our full co-operation. For the present, as is appropriate, we will be dealing directly with the commission on all related matters,” it said.

Concerns that death records were falsified in Bessborough Mother and Baby Home so children could “be brokered in clandestine adoption arrangements” at home and abroad were raised in an internal HSE report in 2012.

The unpublished report highlighted the “wholly epidemic” infant deaths rates at the Cork home and said: “The question whether indeed all of these children actually died while in Bessboro or whether they were brokered into clandestine adoption arrangements, both foreign and domestic, has dire implications for the Church and State and not least for the children and families themselves.”

The report, compiled as part of the HSE’s examination of the State’s role in the Magdalene Laundries as part of the McAleese inquiry, lifts the lid on the culture of cruelty at the home and found the State effectively washed its hands of the women and children.

It reveals the institution, run by the Sisters of the Sacred Hearts of Jesus and Mary, as a place where:

Women and babies were considered “little more than a commodity for trade amongst religious orders”;

“Institutionalisation and human trafficking” took place among various religious orders and State-funded institutions;

Women were provided with “little more than the basic care and provision afforded to that of any individual convicted of crimes against the State”;

Infant death rates were “wholly epidemic” and a “cause for serious consternation”;

The order had a “preoccupation with materialism, wealth and social status”;

A “cold and lonely environment” prevailed, “characterised by harrowing social, emotional and physical isolation and institutionalisation”.

The study, previously released under freedom of information, revealed that from 1934 until 1953 (the only years for which deaths were recorded at Bessborough) 478 children died — a death rate of almost one infant a fortnight for nearly two decades.

The report said it was “curious” that there were no death records for any year following 1953 and, as a result, “one cannot be certain as to the full scope of infant deaths”.

However, in a disturbing revelation, the study raises concerns that the deaths of children may have been falsified so they could be “brokered” for adoption both at home and abroad.

“Simply put, the State had a social problem that it desperately needed to make go away, while the Church had the power and control to turn the ‘problem’ of illegitimacy into a lucrative money-making enterprise,” notes the report.

It notes that, even though detailed financial records and accounts were not given to the HSE by the order, the archives reveal the order earned money from the women for the care of their children and also from the adoptive parents who took them.

One record noted that, in the period from 1929 to 1940, “adoptive parents were charged a sum ranging between £50-60, payable on a monthly payment scheme in exchange for their adopted child”. The report said “further investigation into these practices is warranted”.

The Government did not launch an inquiry into mother and baby homes for almost another two years after the report was compiled in 2012.

In a statement, the Sisters of the Sacred Hearts of Jesus and Mary said it had “no knowledge of any such report”.

“We are in contact with the commission in regard to the Mother and Baby Homes Inquiry, which will be having our full co-operation. For the present, as is appropriate, we will be dealing directly with the commission on all related matters,” said the order.

The Department of Children and Youth Affairs said none of the concerns raised were brought to the attention of the then minister Frances Fitzgerald at the time, but were discussed in the context of McAleese Inquiry under the auspices of the Department of Justice.

It said the minister became involved in the issue of mother-and-baby homes once material around infant deaths in Tuam became public in mid-2014.

“The minister was subsequently tasked by Government with leading its response to these important matters and the Inter Departmental ReviewGroup was set up to assist deliberations on the terms of reference of a Commission of Investigation,” said a statement.

A request for comment from Tusla was not responded to at the time of going to print.

MONTH after month, year after year we peel away another layer of the sordid history of Ireland’s mother and baby homes.

In a country where falling pregnant outside marriage was viewed as something worse than a crime, thousands of women and girls were instead hidden away and their children taken from them.

With no real solution to the ‘problem’ of ‘illegitimacy’, the State was happy to leave it to religious orders and a system of mother and baby homes where, even by the standards of the day, the physical and psychological treatment of women and the removal of their children bordered on criminal.

We have all heard the terms. Sadly, their shock value has waned over time. Only in Ireland can a public be fatigued by terms like forced adoption, illegal adoption, trafficking, slavery, child death and mass graves.

Other countries are shocked. The international reaction to the Tuam babies scandal proved as much. However, at home we have to listen to the usual mantra of ‘Sure those were the times’, ‘Nobody forced these girls to get pregnant’ and the old classic: “Sure the religious did their best’.

The fact that none of these arguments hold water doesn’t weaken their hold over people who want to believe them. The culture of death in mother and baby homes was deemed a scandal at the highest government levels more than 70 years ago. The only thing lacking was the courage in official Ireland to do anything about it.

An archive of material obtained by the Irish Examiner from 1941-1945 in relation to Bessborough mother and baby home — including Department of Local Government and Public Health (DLGPH) inspection reports, letters from the government of the day to the order and correspondence between the order and the bishop of Cork — reveals a disturbing litany of abuse towards women and children that went largely unchecked.

Concerns around infant mortality are continually raised but there are numerous accounts of “emaciated” children, evidence of “insufficient feeding”. One inspector outlines a standard of medical supervision in Bessborough that is deemed “criminally casual” and requires “drastic action”. Such concerns span not months but years.

Not only that, it’s clear that Bishop of Cork Daniel Cohalan takes great offence to the State having the temerity to ask questions about how Bessborough was being run.

Despite being a State-licenced mother and baby home with a maternity hospital paid for exclusively with state funds and taking public cases referred by the Munster area Public Assistance Board, the bishop’s advice to the order was that their duty, above all else, was to Canon law and their loyalty was to their order.

The archive reveals that the nuns running Bessborough were nervous about state inspection from as far back as 1941. The Superioress had written to Cohalan asking advice on how to respond to questions from inspectors about its Query Sheet — its reporting structure for children born and discharged from the home.

Bishop Cohalan’s response in July 1941 is unequivocal — release as little information as possible.

“It must be remembered that you and the Sisters are a religious community. You are not a department of the Cork County Home and Hospital. You are not a government institution. But like the religious who conduct schools or who have the charge of orphans or of industrial institutions, you can do Catholic social work and receive remuneration and allow government inspection. But this inspection must not encroach on your independence as a religious community. The inspection of national schools and of industrial schools does not extend to the domestic affairs and the domestic expenditure of convents. And why should an inspection of Bessboro extend to the receipts from your land or from charitable sources; or to the expenditure on yourselves, on your inmates, on the chapel?,” writes the bishop.

Clearly, the view of the bishop is that Bessborough’s finances are no business of the State. Interestingly, that attitude persists right to this day.

In response to queries from Tusla last year as to why no financial records were handed over as part of the transfer of Bessborough’s records to the State in 2011, the order’s solicitors responded in January of this year stating that the congregation “did not have financial records in the modern sense of audited accounts”.

However, with reference to the reporting of children in the institution, Bishop Cohalan is clear that the nuns should obey Canon law on the matter before all else.

“You are asked the names of the mothers, their home address, their present address. I am sure that no government would knowingly make a demand that would be opposed to Canon law.

“In the case of illegitimate births, the name of the mother cannot be inserted even in the baptismal register without her consent, unless the event be public. In all private cases, whether the mother is rich or poor, the illegitimate mother has a right to her name and fame; and the fact of the birth cannot be published without her consent. So you must not give particulars of name and address in cases where the illegitimate birth is not public.”

In short, the order must put Canon law before the law of the land. This is despite the fact that all mother and baby homes were expected to comply with the Registration of Maternity Homes Act (1934) which stipulated the mandatory reporting of births and deaths.

Canon law 877 states that “in the case of a child of an unmarried mother, the mother’s name is to be entered if her maternity is publicly known or if, either in writing or before two witnesses, she freely asks that this be done”.

However, in the case of a child born in a Bessborough — a state-licenced institution, in receipt of state and local government funding and inspected by the DLGPH — it could be argued that all births were “publicly known” and needed to be registered. Bishop Cohalan concludes by stating that he may have “to take this whole matter up with the government” but warns the nuns that, in the meantime, they must not do “anything that would be a violation of Canon law”.

“And it would be a distinct violation of Canon law and of natural justice to publish the fact of a secret illegitimate birth, with the mother and father’s name, without the permission of the mother and father,” he concludes.

Given the advice that Canon law should supersede State law, it is imperative that the Commission to Inquire into Mother and Baby Homes seeks access to all registers to investigate how the orders operating such institutions recorded births and deaths.

Bishop Cohalan’s intervention, however, wasn’t enough to stop state inspectors repeatedly raising concerns about conditions in Bessborough for the next three years.

In January of 1942, a letter was sent to the Superioress of Bessborough Sr Martina Gleeson, under direction from the Minister for Local Government and Public Health, following an inspection from his medical inspector, Dr Dillon in June 1941.

The letter reports overcrowding, an unsafe building and that the nuns only produced requested documentation “under pressure”.

“The register has not been written up since 1939. No register of confinements was kept. The inspector was unable to satisfy herself as to the provision made for fire-fighting, as the nun in charge did not afford her proper facilities for inspection. The Inspector further reports that she was treated with discourtesy and that generally there was unwillingness to facilitate her in carrying out the statutory inspection under the Registration of Maternity Homes Act, 1934.

She was, for instance, refused admission to a room in the institution which, when eventually unlocked, proved to be a bathroom converted into a bedroom. The register of cases was produced only “under pressure.” It was noted that there was a “tendency to discourage breastfeeding” and that this may be partly responsible for the high infant mortality rate at the institution. It is also noted that the nun in charge had no qualifications in supervising maternity care.

In response, Sr Martina says the issue of the register not being maintained was “a misunderstanding” and argues that women are forced to breastfeed when they feel disinclined to do so.

However, none of these interventions solve the problems at the institution. Although, by 1943, a decision was made for a period to stop sending women referred by the Public Assistance Authority to Bessborough, concerns about its safety continued to mount.

An August 1943 DLGPH inspection report from Alice Litster reveals the treatment of children in Bessborough was causing “uneasiness”.

Ms Litster reveals that, of the 27 babies in the day nursery aged between three weeks to nine months, only eight were breastfed and only three fully.

“The greater number were miserable scraps of humanity, wisened, some emaciated and almost all had rash and sores all over their bodies, faces, hands and heads,” she reports.

The report notes children as old as six were present in the institution “for whose education no provision is made” in contravention of the Compulsory School Attendance Act.

“The condition of the infants and younger children in the institution gives cause for uneasiness. During the year ended 31.3.43, 70 children died. There were 114 admissions (ie, births plus infants admitted after birth during the year and all but one of the 70 deaths were of children under one year),” notes Ms Litster.

Interestingly, the Death Register retained by the order records only 55 infant deaths in this period — a discrepancy revealed by the Irish Examiner last week.

A defence to DLGPH report was mounted by the nuns. With reference to the “miserable scraps of humanity”, the nuns said these children “got this contagion from an outside patient” and that their doctors were “very puzzled and cannot understand what is the cause”.

Regarding the lack of breastfeeding at Bessborough, the nuns said the mothers “have plenty of rest, copious fluids and good nourishing diet”

“In the majority of cases the mothers are inclined to be fretful and have no love for their infants.”

This bizarre attempt to lay the blame for the emaciated appearance of children on their mothers’ lack of love, is taken to even more extreme lengths by Bessborough’s medical officer Dr James T O’Connor, who prepared a report on the cause of infant deaths at the institution in the mid-1940s.

Dr O’Connor notes that although children were dying, in some cases of severe malnutrition, this was not due to the diet or to the lack of breastfeeding. Instead, he argued that “illegitimate” children can sometimes fail to digest breast milk, while pointing out that their gestation period is different to that of a child of marriage.

“In spite of this selection [of food] some of the children lost weight and died. An explanation for this is that some infants saw a remarkable difficulty in digesting food and this is due to a primary failure of the process of assimilation, whether for particular food, or for foods in general, even in some cases where the child is breast fed, they do not assimilate the nourishment in the milk. This is more remarkable in illegitimate children.” “It must be remembered that the period of Gestation of these children is far different to that of the married woman. The girl worries a great deal and is mentally upset over her condition. She is constantly trying to conceal the fact that she is pregnant, and in some cases every effort is made to get rid of the foetus. All this has undoubtly (sic) a most injurious effect on the developing foetus resulting in weak and defective children who have a poor resistance to disease and defective powers for assimilating food,” he noted.

However, a report by the County Medical Officer for Health highlighted that Dr O’Connor visited on average twice weekly and there “appears to be no written agreement” in relation to his conditions of service. Although paid £120 per year by the nuns, the County Medical Officer noted that not every infant was seen during his visits and “no proper records, such as weight cards, etc are kept for each child”.

By Christmas of 1944, little had changed. A report prepared by DLGPH inspector Florence Dillon had left parliamentary secretary at the DLGPH Dr Con Ward — effectively the health minister of the day — in no doubt that “drastic action” needed to be taken to deal with Bessborough.

In a letter sent on his behalf to the assistant secretary at the department, he is blunt in his opinion of conditions at the mother and baby home.

“Dr Ward feels satisfied that the medical supervision in the institution cannot but be criminally casual and he directs that the fullest report envisaged by the chief medical adviser be immediately obtained and submitted to him,” states the letter.

In January of the following year, the DLGPH wrote to the overall head of the Order in Chigwell in England advising that it had provided substantial funding to Bessborough and that unless changes were made, including the re-organisation of the management and staffing of the home, the government would be forced to “undertake a complete review of the policy whereby responsibility for this type of institution has been committed to your Order.” The letter ends with a demand that a new Superior be appointed who possesses “satisfactory qualifications and experience in the administration of an institution dealing with midwifery and child care”.

While the overall head of the order agrees to this re-organisation, the interference of the State in the affairs of the nuns irked Bishop of Cork Daniel Cohalan who wrote to Dr Ward in February 1945 to express his annoyance.

“Rev Mother Martina has informed me that the Mother Superior in England was asked to remove her. That procedure was scarcely correct. Mother Martina is Reverend Mother of the Community of Sisters, it is an ecclesiastical appointment; it was not a correct thing to call for her removal,” he wrote.

However, the department is equally bullish in its response to the bishop stating that should the numbers of children reported as dying in Bessborough make it into the public domain, it would result in a “public scandal”.

“The parliamentary secretary is only concerned with her position as matron of a home in which the death rate has reached an exceptionally high figure. The fact that 102 babies died in the institution before reaching the age of 12 months during the year 31st March last — the total infants born in the home and admitted after birth in that year being 124 — is viewed with disquietude.

“Apart from any public scandal which might result, the parliamentary secretary felt that the case called for immediate action and that to allow the Rev Mother Martina to continue as manager would mean acquiescence on his part in the state of affairs which has been disclosed,” stated the letter.

The 102 deaths referred to an 82% death rate at Bessborough, which was reported to the DLGPH inspector Alice Litster for year ended 31 March 1944. The order’s own death register records just 77 deaths for this period — a discrepancy which it has declined to offer an explanation for.

Although the order tried to delay the removal of Sr Martina, the threat of it being barred from operating a mother and baby home and losing the state funding that resulted meant that by September 1945, it agreed to remove her from Bessborough to be replaced by Mother Rosemonde.

A handwritten note from September 1945 acknowledges the change and notes: “We might give the new Rev Mother, who appears to be very capable, a chance to pull Bessboro together before we press for a withdrawal of the maternity licence”. In 1946, the level of infant death had fallen from 30 to 10. In 1947, it had risen to 19 before falling dramatically to single figures until 1953. By this time, adoption had been made legal in Ireland. The order has claimed it maintained no death register after this point.

It is noteworthy that despite an infant mortality rate which peaked at 82%, the government, at no point during this period, withdrew Bessborough’s licence to operate as a mother and baby home. You’d wonder how bad things would have had to be before someone had the courage to make that decision.